A long history surrounds the concepts, theories, and practices that employ muscle imbalance. In brief, here are some of them:
– In 1741, French physician Nicolas Andre was one of the first to discuss muscle imbalance in his writings. He coined the term “orthopedia” which means “straight child” and advanced the notion that scoliosis, abnormal curvatures of the spine, was due to muscle imbalance.
– In 1890 French scientist Étienne-Jules Marey made the first recording of a muscle’s electrical activity, and coined the term electromyography. This would become a common instrument to measure muscle imbalance.
– In 1900, Nobel laureate Sir Charles Scott Sherrington, an English neurophysiologist, proposed his law of reciprocal innervation, which stated that muscle inhibition usually generates tightness in opposite (antagonist) muscles. Despite this notion, most of the therapies associated with muscle imbalance were directed at tight and painful muscles, which, within the tight/weak model of muscle imbalance, were the most symptomatic and easiest to detect. This involved using braces and surgery by many practitioners.
– In 1949, American physical therapists Henry and Florence Kendall’s first textbook on manual muscle testing appeared, which evaluated weakness in polio patients. This marked a change in approach in treating muscle problems as both tight and weak muscles were observed and measured.
– In the early 1960s, clinical pioneers Dr. George Goodheart from the U.S., and Czechoslovakian Dr. Vladimir Janda took different paths in their pursuit of treating patients with muscle imbalance. Goodheart, influenced by Kendall’s work, promoted the idea that muscle inhibition (weakness) was the primary cause of muscle imbalance associated with everyday aches and pain, along with more serious disabilities. This triggered a muscle-testing revolution among many clinicians seeking to find and fix mechanical dysfunction. Janda took the tight muscle road like some of his predecessors, directing therapy at the tight side of muscle imbalance. Both clinicians developed huge multidisciplinary followings that continue today.
– As the jogging and fitness boom of the 1970s evolved, strength exercises such as weight lifting and various workout machines became popular. One result is that many people developed muscle imbalance by creating too much strength in one muscle in relation to another.
Today, there is usually a clear division among the many types of therapists who treat muscle imbalance. Some see the primary cause, and therefore direct their treatment, to the tight side while others focus on the weak muscles to correct the problem. On one hand, there are chiropractors, osteopaths, physical therapist, medical doctors, and massage therapists (to name a few) who evaluate and treat the tight part of muscle imbalance. While others in these same professions evaluate and treat weakness as the primary cause of muscle imbalance. I have always considered the weak muscle to be the primary problem in most cases, with the tightness a secondary problem.
Self-Care of Muscle Imbalance
While treatment by a health-care professional is sometimes necessary, many people are able to correct their own muscle imbalances. There are a number of ways you can accomplish this. Furthermore, the following approaches to correcting muscle imbalance can also prevent a recurrence.
– First and foremost is to address the cause or causes of muscle imbalance (discussed in Part 1).
– Second, allow your body to do the work. Muscle imbalance will often correct itself naturally in a body that’s most fit and healthy. This included the right exercise routine, a healthy diet, and proper management of stress.
– One powerful way to correct muscle problems is by developing a great aerobic system. In particular, the process of warming up before a workout and cooling down afterwards can immediately correct many dysfunctional muscles.
– Spending more time being barefoot can encourage many muscles to function optimally, correcting imbalance. Since the muscles in the foot significantly influence body-wide posture, being barefoot can help all skeletal muscles.
– Eliminating chronic inflammation can correct muscle imbalance—as the body’s natural anti-inflammatory chemicals are also powerful regulators of muscle function.
– Since pain can cause muscle imbalance, finding the source of pain, and eliminating it, also can correct muscle problems.
– The application of cold (cryotherapy) can also help correct muscle imbalance. But extended, continued use of ice placed directly against the body must be pursued with discretion to prevent muscle damage.
NSAIDs and Inflammation Can Cause Muscle Imbalance
Many people use NSAIDs when they have aches and pains, including aspirin, ibuprofen, Advil, Motrin, Nuprin, Naprosyn and other prescription and over-the-counter drugs. But these can weaken muscles as one of their side effects. They can even worsen the problem despite providing symptomatic (and temporary) relief.
The balance of dietary fats control inflammation, and conversion of the omega fats to inflammatory and anti-inflammatory chemicals relies on an important enzyme called cyclooxygenase, or COX. There are actually two COX enzymes, and many people are familiar with the term “COX-2 inhibitors.” Aspirin and other NSAIDs temporarily block the COX enzymes so much less of the inflammatory chemicals are formed. While this reduces the inflammatory chemicals, it also lowers the beneficial anti-inflammatory ones. In addition, the cause of the problem—fat imbalance—goes untreated. So, if taking NSAIDs makes you feel better, it usually indicates that your fats are not balanced. Here’s a quick review on how to improve the balance of fats to control inflammation:
1. First, eat approximately equal amounts of omega-6 and -3 fats. It does not necessarily have to be at each meal, but in the course of a day or week, strive for an overall balance. While this 1:1 ratio of -6 and -3 is ideal, the typical Western diet is often 5, 10, or even 20:1. It’s no wonder there’s an epidemic of chronic inflammation, pain, and muscle imbalance. One reason for this is the high intakes of omega-6 vegetable oils such as corn, soy, safflower, canola and peanut, and the low consumption of omega-3 fats, especially from wild fish, which is the best source, with beans, flax seeds and vegetables contain much smaller amounts.
2. By eliminating vegetable oils (substitute olive or coconut) and taking fish oil capsules, which are high in the most potent omega-3 fat, EPA, the balance of fats can significantly improve. (The omega-3 flax oil is less effective.)
3. Avoid refined carbohydrates, including sugar, which can increase the conversion of omega-6 oils to inflammatory chemicals.
4. A number of other dietary factors can impair the production of anti-inflammatory hormones, thereby increasing the inflammatory ones: low levels of vitamins B6, C, E, niacin, and the minerals magnesium, calcium, and zinc (these should come from a healthy diet); trans fat; low protein intake; excess stress; and aging, which increases the risk of more inflammatory chemicals.
A Note About Other Types of Pain Drugs
In addition to NSAIDs, a second type of over-the-counter drug used for pain relief includes acetaminophen. The most popular non-prescription one is Tylenol, which doesn’t act by reducing inflammation, and therefore is less likely to interfere with healing and recovery. In fact, it’s not entirely clear how it works, but liver stress is among the side effects; the body needs to break down these drugs in the liver, which requires large amounts of the amino acid cysteine (best obtained in the diet from whey consumption).
Narcotics, such as opiates, are another type of pain reliever. These act in the brain to reduce the sensation of pain and also don’t affect inflammation. However, they are easily addictive, and their use as a pain reliever wears off as the brain cells become desensitized. Common narcotics prescribed for pain include morphine and other opioid drugs such as codeine and oxycodone (OxyContin).
Yet another pain-relieving drug is THC, the active component in marijuana, which controls pain by stimulating certain receptors in the brain, similar to those that opiates act upon. THC can stimulate the brain’s natural opiates, like endorphins. The only prescription form is the product Marinol, although many states now have medical marijuana laws.
Manual Biofeedback
Among the many tools I used in private practice to help correct muscle imbalance was manual biofeedback. It’s a safe and effective, and relatively easy approach for use by most healthcare professionals, with its basic techniques used by many lay people as well.
Manual biofeedback helps the brain and body restore and balance muscle function. It addresses the problem of muscle imbalance that’s due to a wide range of problems. It can be used in children and adults of all ages who have suffered minor local muscle injury to more serious brain and spinal cord injuries. This therapy helps restore muscle balance by strengthening weak muscles and relaxing tight ones. It’s a simple hands-on system that requires no equipment.
Most people who have injuries associated with muscle imbalance fall into at least one of two categories:
• Local muscle injury is the most common cause of physical problems, and is often associated with trauma to the muscle itself, such as the result of a fall, a so-called pulled muscle, a twisted ankle, or other injury. Micro-trauma is even more widespread; it’s the accumulation of minor physical stress in a muscle or joint, often unnoticed while it’s happening, eventually causing a more obvious muscle problem. Daily living produces significant wear and tear on the body’s mechanics—a stress that most people should adapt to well. But often, this stress is not compensated for and muscle imbalance develops. In addition to exercise, too much sitting, repetitive motion injury, or walking in poor-fitting shoes often leads to micro-trauma, which in turn ultimately causes muscle problems. Local muscle injuries can result in anything from minor annoying ache to a serious or chronic debilitating condition.
• Brain or spinal cord injury can occur at any age, even before birth, and usually milder forms can be found in many individuals who don’t realize they have a relatively minor problem that still causes muscle imbalance. Trauma, infection, or reduced nutrient supply can easily cause brain or spinal cord damage resulting in poor muscle function. Many people are also involved in an auto accident or other trauma that can often sustain a brain or spinal cord injury—sometimes so apparently minor that many doctors or hospitals say you’re fine, even after an MRI or CT scan.
Manual biofeedback can help promote and restore muscle balance; it not only helps locomotion and posture, but can improve brain function as well, including speech, vision, balance, memory, and even intellect. And because muscles have other important functions, such as energy production, circulation, and immune activity, increasing physical movement can improve overall health.
Manual Biofeedback Can Be Used by Anyone
While healthcare professionals regularly apply the art and science of manual muscle testing, biofeedback and other hands-on assessment and therapeutic activities, there are tens of thousands of other individuals who learn to use these important techniques everyday. Almost everyone has used tweezers to take out a deep splinter (minor surgery), bandage an abrasion (emergency first aid) or in some instances even save a life by learning CPR (cardiopulmonary resuscitation). And it’s not uncommon to see, in many public areas, including airplanes, restaurants and malls, automatic cardiac resuscitators for emergency treatment in cases where a person’s heart stops—complete with instructions for the average person to use to save a life.
Manual biofeedback is just as practical, if not easier, than some of these techniques, and its successful application to the majority of physical aches and pains can be surprisingly simple once a bit of experience is attained. Manual biofeedback can be used in the young and old, including children, athletes, and everyone else.
While traditional EMG biofeedback uses computer equipment, including mechanical sensors and electrodes attached to the skin, manual biofeedback does not use any equipment. Instead, it relies on the neurological sense of the person using manual biofeedback. This personal approach also allows for the recruitment of more brain-body stimulation with verbal, visual, tactile, and other sensory cues that further enlists the patient’s participation and motivation. Like many forms of biofeedback, manual biofeedback relies on basic manual muscle testing.
While it takes another person to use manual muscle testing and the basic biofeedback therapies, with respiratory biofeedback, you can do it on yourself without assistance from others.
The Family Hope Center, which is based in Philadelphia, helps brain-injured children and teaches their parents how to apply many home therapies. A couple of years ago, the Center asked me to make an instructional DVD on manual biofeedback. I was happy to be of assistance. The DVD and users manual that I created contains an introduction to the concepts of muscle imbalance and how to remedy it, respiratory biofeedback and proper breathing techniques. It also includes the detailed use of manual biofeedback, and a library that demonstrates how to test and perform manual biofeedback on all the body’s major muscles.
This DVD is now used by virtually all types of individuals dealing with sports injuries, common aches and pains, as well as improving brain function. (For more information, visit the manual biofeedback pages.)
Breathing Muscles
Of all the vital muscles necessary for optimal health and fitness, one of the most important is the diaphragm. This breathing muscle is located on top of your abdomen and under your lungs. The large flat muscle allows you to breathe by pulling in oxygenated air and expelling unwanted carbon dioxide. In many people, the breathing mechanism may be the weak link to improved overall function.
Poor diaphragm muscle function—muscle weakness—can lead to various problems such as general fatigue or poor function of many body areas due to reduced oxygenation. In this case, less air enters the lungs and the blood does not receive the proper amount of oxygen. Moreover, poor exhalation does not eliminate the necessary amount of carbon dioxide. Correcting diaphragm muscle weakness can allow the body to improve the function of many other muscles.
Everyone can incorporate the actions of normal breathing into their day—not necessarily only during exercise, but also during rest or down time. This can help improve one’s health, but also repair muscle imbalance.
Normal Breathing
It’s natural to take breathing for granted, until you experience a breathing difficulty. But some people breathe improperly and don’t even realize it, while many others could improve their breathing by controlling stress. Normal breathing is associated with proper muscle movement—the most important being the abdominal muscles in the front and sides of your abdomen and the diaphragm muscle. These muscles work together allowing us to efficiently breathe in and out. Without normal breathing, the abdominal and diaphragm muscles may work improperly, and even cause other muscles to not work. In this scenario, body movement—posture and gait, for example—can become impaired, oxygen can be reduced, and other problems can occur.
The abdominal muscles also help physically support your body structure—the spine, the low back, pelvis, shoulders, and even the neck. The abdominals not only help you walk, jog, play any sport like tennis or golf more efficiently, but also sit, stand and even sleep properly. In some cases, improper breathing is the beginning of a complex set of imbalances causing an injury to the low or middle back, hip, and shoulder.
Given the importance of the abdominal and diaphragm muscles, let’s look more closely at the two components of normal breathing—inhalation and exhalation:
1. During inhalation the abdominal muscles relax and extend outward, while the diaphragm muscle moves downward. This movement allows air to enter the lungs more easily and is accompanied by a slight whole-body backward extension, especially of the spine.
2. During exhalation the abdominal muscles contract and tighten, and are gently pulled inward; the diaphragm muscle “relaxes” with an upward movement. This helps push air out of the lungs, with a slight whole-body flexion.
By watching another person’s breathing, especially the belly moving out on inhalation and in on exhalation, one can often tell if it’s correct. You can also evaluate your own breathing by feeling the muscles move. So try this quick experiment:
• Place the palm of one or both hands on the abdomen (over your belly button).
• Slowly breathe in and feel the abdominal muscles expand outward. Your belly should get bigger during inhalation.
• Slowly exhale and feel the abdominal muscles tighten and be pulled inward. The belly is more flat on exhalation.
During normal breathing, most movement occurs in the abdominal areas, and only slightly in the chest, which expands more with much deeper breathing.
Those who breathe improperly often move their muscles opposite that of normal—for example, they sometime pull their belly inward on inhalation. In other cases, the chest is quickly and fully expanded and the abdominal area doesn’t get a chance to move properly. These poor patterns of breathing can be caused from stress, the stigma of not showing their belly during inhalation. The use of so-called slimming garments that wrap around the belly can actually cause the abdominal muscle to weaken and therefore should be avoided. Even over-exercising the abdominal muscles—typically with sit-ups or crunches—making them too tight to relax. In a real sense, poor breathing is the result of muscle imbalance—weak diaphragm and tight abdominal muscles are a common example.
It’s particularly important to be aware of your breathing during times of stress, which is often when breathing can switch from normal to abnormal as you hold more tension in your abdominal and pelvic muscles.
If your breathing is abnormal or irregular it’s important to immediately retrain the breathing mechanism. This can be done using respiratory biofeedback (see the 5-Minute Power Break). The procedure is simple using the steps just outlined above for normal inhalation and exhalation.
Muscle Balance and Bone Health
In general, by maintaining proper muscle balance and by being healthy and fit, you can significantly reduce the risk of bone problems, including fractures and osteoporosis—injuries that occur in both men and women.
There are a number of other factors that significantly influence bone strength, in particular, the proper mineralization of bone. This is referred to as bone density. Your bones are not unlike muscles, intestines, skin and other tissues throughout the body. They are full of life—living parts of us. As such, bones are always metabolically active. This means there is always an ongoing influx and output of nutrients—calcium, sodium, magnesium, zinc, protein and others—which provides us with our level of bone density. If your bones lose more calcium, for example, than they take in, you risk weak bones vulnerable to injury and disease. Combine this with even minor muscle imbalance and the risk of bone injury is high.
In addition to muscle balance, here are some other key factors that greatly influence bone health:
– Aerobic fitness: this helps maintain support of bones.
– Gravity stress: this is associated with physical activity that improves bone density. For example, someone who only bikes for exercise might add walking or jogging to their workout routine.
– Hormone balance: both estrogen and testosterone in particular help regulate bone mineralization, as do adrenal hormones that regulate sodium.
– Adequate calorie intake: low-calorie diets can weaken bones.
– Proper fat and protein intake: both are necessary for bone health.
– Avoiding chronic inflammation: this problem can reduce bone density.
– Sun exposure: your main source of vitamin D, which regulates calcium.
When a bone is stressed, whether from physical strain, dietary or hormonal inadequacy, too little vitamin D, or disease, at least three types of injuries can result.
– A stress reaction is a subtle bone injury, microscopic in nature. It causes vague discomfort following physical activity, even just walking around. This problem can’t be seen on an X-ray or other scan, making it somewhat elusive.
– A stress fracture, which is more painful and usually restricts activity, can occur if more stress affects the bone. It can often, but not always, be diagnosed with an X-ray. It is also an example of a microscopic bone injury.
– A bone fracture or break can occur with higher levels of stress. There are many different classifications of fractures depending on how extensive it is and where the break is located. While more serious fractures can require surgical repair, many others are capable of healing with just a cast, or little or no support. In some cases, poor health is associated with bone injury, such as osteoporosis where reduced bone density contributes to a compression fracture (collapsed vertebrae). Fractures are more obvious on X-ray.
If you experience trauma—a severe twisted ankle, a hard fall, or drop a heavy weight on your foot—and injure a bone, healing occurs much more rapidly if you have better muscle balance and are healthier overall. This is true even for an extreme case where surgical repair is necessary. Most importantly, whether a stress fracture from exercise or a more serious bone injury such as a broken hip from a fall, there are usually key causes of more severe health problems that need to be addressed.
Stress fractures
The most common bone problem in active people is stress fracture. They can occur without obvious trauma, and are often due to muscle imbalance interfering with weight bearing, gait, and other movement. While the bones in the legs (tibia and fibula) are common sites of stress fractures, they can also occur in the foot’s metatarsal and navicular bones, the pelvis, and wrist.
Pain from a stress fracture typically improves with rest and worsens with activity. There is often some swelling in the area, but sometimes it’s not noticeable. The swelling around the site of fracture may prevent a proper diagnosis by X-ray if taken within the first two weeks of injury. Only after some healing has taken place will the X-ray show the problem. In these situations, a bone scan may help locate the stress fracture when the X-ray can’t.
Most stress fractures will heal well in a healthy person without major therapy. Rest, cooling the site of fracture, cessation of weight-bearing exercise, and hard-soled flat shoes are often sufficient, but each case must be treated individually. Aspirin and other NSAIDs must be avoided as they can delay bone healing.
Just as important is the fact that something caused a stress fracture to occur; and that something—some imbalance in muscles, hormones, diet, or often a combination of problems—must be found and corrected. If this does not happen, you are vulnerable to future fractures.
A low-fat diet may be associated with a higher incidence of stress fractures—statistically more in physically active females. Fats are important for many aspects of health, with certain fats helping to carry calcium into bones and muscles.
The importance of optimal muscle function for bone health is often not addressed by health-care professionals. However, this may be the most important contributing factor in stress fractures. Three muscle problems can exist in this context:
– Muscle imbalance can cause reduced support and increased stress on specific areas of the skeleton.
– Poor aerobic function, as seen in the aerobic deficiency syndrome, can result in the daily loss of bone support.
– Low muscle mass, such as that seen in sarcopenia, is associated with poor strength, loss of bone support, and increased vulnerability to falls and other injury.
Muscle balance is a key part of physical health and fitness. An imbalance of two or more muscles typically results in one being weaker, and often not symptomatic, and another too tight. This imbalance can be a primary cause of various aches and pains, some minor and merely annoying but others debilitating. Correcting muscle imbalance is something you can do—it’s one of the jobs of a health and fit body. In some cases, finding a healthcare professional may be necessary to accomplish this task.
